Telemedicine Providers Research Articles

"Trust Women": Characteristics of and learnings from patients of a Shield Law medication abortion practice in the United States.

The 2022 Massachusetts Shield Law protects telemedicine providers who care for abortion seekers in other states from criminal, civil, and licensure penalties. In this article we explore the characteristics of patients of The Massachusetts Medication Abortion Access Project (The MAP). The MAP is an asynchronous telemedicine service that offers mifepristone/misoprostol to abortion seekers in all 50 states who are at or under 11 weeks pregnancy gestation on initial intake. The MAP charges USD250 using a pay-what-you-can model. We analyzed medical questionnaires and payments submitted by patients who received care from The MAP during its first 6 months of operations using descriptive statistics and for content and themes. From October 1, 2023-March 31, 2024, 1994 patients accessed care through The MAP. Almost all (n = 1973, 99%) identified as women/girls and about half (n = 984, 49%) were aged 20-29. The MAP cared for patients in 45 states; 84% (n = 1672) of these patients received pills in abortion ban or restricted southern states. Patients paid USD134.50 on average; 29% (n = 577) paid USD25 or less. Nearly two-thirds (n = 1293, 65%) received subsidized care; financial hardship featured prominently in patient comments. Considerable demand exists for medication abortion care from Shield Law providers. The MAP demonstrates that providers can trust women and other pregnancy capable people to decide for themselves whether to obtain medication abortion pills by mail and to pay what they can afford without being required to justify their need. Identifying ways to support Shield Law provision and further subsidize abortion care are needed.

Determinants of Behavioral Intention Toward Telemedicine Services in Indonesia Post-Pandemic COVID-19

The COVID-19 pandemic has significantly disrupted daily life & accelerated the adoption of digital technologies across various sectors, including healthcare. In Indonesia, this shift has prompted the rapid development and implementation of Telemedicine services by both start-ups and established healthcare institutions. This study aims to identify the factors that influence customer intention to use Telemedicine services in the post-pandemic period, using the Unified Theory of Acceptance and Use of Technology (UTAUT2) model. The research focuses on five key variables: Price Value, Effort Expectancy, Geographical Location, Performance Expectancy, and Social Influence. Data collected from 507 respondents across Indonesia through an online questionnaire reveals that user satisfaction is critical for further use of Telemedicine services. The findings indicate that improvements in the affordability, user-friendliness, accessibility, effectiveness, and social endorsement of Telemedicine services significantly enhance user satisfaction. The study provides practical recommendations for Telemedicine providers to improve these factors, thereby increasing customer retention and adoption rates. This research contributes to the understanding and offers insights for optimizing Telemedicine services in Indonesia in the evolving post-pandemic behaviors

Visit Experience and Fulfillment of Care Needs in Primary Care Differs for Video Visits Compared to In-person and Chat Visits.

There is a lack of research comparing patient experience and to what extent patients' care needs are fulfilled in telemedicine compared to in-person care. To investigate if patient experience and fulfillment of care needs differ between video and chat visits with direct to consumer telemedicine providers compared to in-person visits. Cross-sectional study. Adults visiting a primary care physician in person or via chat or video in Region Stockholm, Sweden, October 2020-May 2021. Patient-reported visit experience and fulfillment of care needs. The sample included 3315 patients who had an in-person (1950), video (844), or chat (521) visit. Response rates were 42% for in-person visitors and 41% for telemedicine visitors. Patients were 18-97years old, mean age of 51years, and 66% were female. In-person visitors reported the most positive patient experience ("To a very high degree" or "Yes, completely") for being listened to (64%), being treated with care (64%), and feeling trust and confidence in the health care professional (76%). Chat visitors reported the most positive patient experience for being given enough time (61%) and having care needs fulfilled during the care visit (76%). Video visitors had the largest proportion of respondents choosing "To a very low degree" or "No, not at all" for all visit experience measures. There were statistically significant differences in the distribution of visit experiences between in-person, video, and chat visits for all visit experience measures (P < 0.001). Video visits were associated with a more negative visit experience and lower fulfillment of care needs than in-person visits. Chat visits were associated with a similar patient experience and fulfillment of care needs as in-person visits. Chat visits may be a viable alternative to in-person visits for selected patients.

Intention to use telemedicine services during a health crisis: A motivation‐opportunity‐ability theory approach

AbstractTelemedicine, despite its longstanding presence, has emerged as a valuable resource amidst health crises. Yet, research on individuals' willingness to embrace telemedicine in such circumstances remains scarce. This article employs the Motivation–Opportunity–Ability theory to construct a novel framework for investigating how motivational, opportunity‐related, and ability‐related factors influence individuals' intention to use telemedicine during a health crisis. A sample of 468 respondents from Indonesia participated in an online survey. The data were analyzed using covariance‐based structural equation modeling and the Hayes PROCESS macro. The findings revealed that contamination avoidance, telemedicine usability, and privacy concerns significantly influence the intention to use telemedicine services. Moreover, the findings also confirmed the moderated moderating effect of e‐health literacy and technology optimism on the relationship between contamination avoidance and intention to use telemedicine services. By deepening our understanding of the factors shaping individuals' intention to use telemedicine services, this study makes valuable academic contributions to the field of telemedicine adoption literature. Additionally, it provides practical insights for telemedicine providers aiming to enhance individuals' intention to use telemedicine services during critical health situations.

Quantifying the impact of telemedicine and patient medical advice request messages on physicians' work-outside-work

The COVID-19 pandemic has boosted digital health utilization, raising concerns about increased physicians’ after-hours clinical work ("work-outside-work”). The surge in patients’ digital messages and additional time spent on work-outside-work by telemedicine providers underscores the need to evaluate the connection between digital health utilization and physicians’ after-hours commitments. We examined the impact on physicians’ workload from two types of digital demands - patients’ messages requesting medical advice (PMARs) sent to physicians’ inbox (inbasket), and telemedicine. Our study included 1716 ambulatory-care physicians in New York City regularly practicing between November 2022 and March 2023. Regression analyses assessed primary and interaction effects of (PMARs) and telemedicine on work-outside-work. The study revealed a significant effect of PMARs on physicians’ work-outside-work and that this relationship is moderated by physicians’ specialties. Non-primary care physicians or specialists experienced a more pronounced effect than their primary care peers. Analysis of their telemedicine load revealed that primary care physicians received fewer PMARs and spent less time in work-outside-work with more telemedicine. Specialists faced increased PMARs and did more work-outside-work as telemedicine visits increased which could be due to the difference in patient panels. Reducing PMAR volumes and efficient inbasket management strategies needed to reduce physicians’ work-outside-work. Policymakers need to be cognizant of potential disruptions in physicians carefully balanced workload caused by the digital health services.

Cardiac Remote Monitoring Devices and Technologies: A Review for the Perioperative Physician and Telemedicine Providers.

Cardiovascular complications are a major cause of morbidity and mortality after surgery, necessitating adequate and thorough preoperative risk stratification and screening. Several technological advances in cardiac remote monitoring have improved the assessment and diagnosis of cardiovascular disease in patients before and after surgery. These devices perform measurements of physiological function, including vital signs, and more advanced functions, such as electrocardiograms and heart sound recordings. Some of the currently available devices include Fitbit® (Google LLC, Mountain View, CA, USA), BodyGuardian® (Preventive Inc.,Rochester, MN, USA), ZephyrTM Performance Systems (Zephyr Inc., Annapolis, MD, USA), Sensium® (The Surgical Company, Amersfoort, UT, The Netherlands), KardiaMobile® (AliveCor, Mountain View, CA, USA), Coala® Heart Monitor (Coala Life Inc., Uppsala, Sweden), Smartex® Wearable Wellness System (Smartex, Porto, LX, Portugal), Eko® CORE and DUO (Eko Health,Emeryville, CA, USA), and TytoCareTM(TytoCare Ltd., New York, USA). Early studies have applied these devices to asymptomatic individuals and those with known cardiovascular disease with good sensitivity and specificity for electrophysiologic diagnosis. These devices carry several technical and other limitations, somewhat restricting the generalization of their use to all patients. However, information gathered from these devices can further guide anesthetic technique, operative timing, and postoperative follow-up, among other variables. As telehealth becomes more prevalent and comprehensive, it is paramount for the perioperative physician to be familiar with the available cardiac remote monitoring technologies.

Personal Data Protection in Telemedicine: Comparison of Indonesian and European Union Law

Telemedicine allows patients to receive remote medical consultation, diagnosis, and treatment through a digital platform. However, with the development of telemedicine, personal data protection has become one of the main concerns. This research aims to compare the regulation of personal data protection in telemedicine services in Indonesia and the European Union. The type of research in this scientific article is Normative Juridical Research with a comparative legal approach. The data sources obtained in this paper are primary data and secondary data. The data collection method is a literature study. The data analysis method in this paper uses a qualitative approach. The results show that personal data protection in Indonesia is regulated by Law Number 27 of 2022 concerning Personal Data Protection (PDP Law). While in the European Union, Personal Data Protection is regulated in the General Data Protection Regulation (GDPR) which regulates the collection and use of personal data by organizations. Some similarities in personal data protection in both telemedicine in Indonesia and in the European Union are that the same consent requires telemedicine providers to obtain clear and explicit consent from patients. Both telemedicine providers must not disclose the patient's personal data to third parties without the patient's consent. Telemedicine providers to implement security measures to protect patient personal data. Both Indonesia and the European Union give patients the right to access, correct, delete, and limit the use of their personal data

The Role of Self-Determination Theory in Explaining Patients' Motivation to Continue Using Telemedicine in a Post-Pandemic World

COVID-19 has led to a considerable increase in telemedicine use by physicians and patients. However, usage is expected to decline post-pandemic despite the benefits in terms of convenience, reachability, accessibility, and cost. We are investigating antidotes to this supposed decline from the patient’s perspective: Which psychological needs and motivations may increase the patient’s satisfaction with telemedicine and her or his continuance intention? Our research combines the well-known Expectation-Confirmation Model (ECM) from satisfaction research with motivation antecedents and outcomes according to Self-Determination Theory (SDT). We developed and shared a self-administered questionnaire in online health communities. A patient sample (n = 464) participated in the survey. A subsample (n = 151) had experiences with medical teleconsultation or similar medical applications, whereas other patients (n = 313) with teleconsultations in administration, business, or education only. Overall, both subsamples reveal almost the same results. Perceived usefulness (e.g., time-saving and quick access to healthcare treatment) is the most important continuance intention predictor. However, psychological needs from SDT (e.g., perceived competence and perceived relatedness) also determine motivation, satisfaction, and continuance intention. The combination of ECM and SDT appears to lay the foundation for improved research for digitalized healthcare delivery. Further, both subsamples demonstrate high satisfaction with telemedicine. Nevertheless, telemedicine providers and marketers should carefully optimize the patient journey while minimizing patient waiting time and focus on understanding users’ health needs to differentiate their services in the market.

Multi-Dimensional Analysis of Japanese Telemedicine Patient Satisfaction.

Telemedicine is a growing segment of the healthcare industry. As telemedicine gains prominence in Japan, the importance of telemedicine patient satisfaction research will also grow. This study examines whether Japanese patients are equally impacted by the same latent dimensions discovered in the multi-dimensional service satisfaction model used by a United States (U.S.) study. The subjects (n = 110) were patients who received telemedicine service between January and December 2023 at Juntendo University Hospital, Tokyo, Japan. Patient satisfaction perceptions were collected using a questionnaire composed of Likert scale items. Overall patient satisfaction served as the dependent variable, and patient perceptions of various aspects of the service were the independent variables. LASSO regression analysis was used to test the impact of the independent variables on overall patient satisfaction along with cluster analysis to examine the satisfaction ratings based upon patient characteristics. Japanese patient perceptions of telemedicine health benefits were the most impactful driver of overall satisfaction. Cluster analysis indicated that males were generally more satisfied than females. The least satisfied patients were predominately female and those experiencing telemedicine for the first time. Patients receiving service from a specialist physician were least satisfied with the telemedicine financial costs. Patient satisfaction levels were found to be highly impacted by perceptions of the health benefits received and the non-financial costs of service. These benefits could be highlighted by Japanese telemedicine providers to increase utilization of telemedicine services. Patient satisfaction was also found to be influenced by patient-centered care (ie, the "soft skills" of providers) to a lesser degree. Therefore, Japanese telemedicine providers may benefit from developing patient-centered communication skills. The model used provides nuanced understandings of telemedicine patient satisfaction, which highlights where targeted improvements in Japanese telemedicine patient satisfaction are likely to be most impactful.

A perspective on the scope of videoconferencing-based telemedicine in respiratory diseases outpatient clinic.

Telemedicine is rapidly expanding across various fields worldwide. While it finds application in respiratory diseases due to the imperative need for protection against the risk of transmission and the close monitoring of patients with chronic diseases, there is a scarcity of publications detailing telemedicine experiences in respiratory diseases. This study aims to retrospectively evaluate the prospective management of patients with respiratory diseases through videoconference-based telemedicine, intending to establish a foundation for its judicious application in pulmonology cases. In this descriptive study, anonymized medical records of all 478 patients assessed via videoconference-based telemedicine over an eight-month period from June 2020 to February 2021 were reviewed. The analysis included demographic characteristics, disease history, attendance methods, the necessity for in-person physical examination after the initial videoconference (VC) session, the inclusion of investigations, pre-diagnosis, diagnosis processes, follow-up period, and outcomes. Follow-up data for all patients included in the study were reviewed at the end of June 2021. Median age of the patients was 55 (44-67), with a male predominance of 55%. Approximately 30% resided in a city other than the one in which the physician offering telemedicine was situated. Seventy-nine (16.7%) individuals received telemedicine via VC sessions without the requirement for any in-person examinations. The most prevalent disease among those who applied for telemedicine was asthma. Median duration of the initial VC session was 13 (8-18) minutes. At least half of the individuals seeking videoconference-based telemedicine for chronic respiratory disorders, such as asthma, COPD, and interstitial lung disease, had previously been followed by either the telemedicine provider or another physician in the same hospital. However, the vast majority of telemedicine applications in disease categories such as COVID, post-COVID, pulmonary nodules, and lung cancer were submitted by first-time applicants. This pioneering study suggests that videoconference-based telemedicine may be an alternative/complementary tool for patients, particularly those with chronic respiratory diseases.

User perceptions of COVID-19 telemedicine testing services, disease risk, and pandemic preparedness: findings from a private clinic in Hong Kong.

During the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has been regarded as a method for providing safe access to healthcare. Here, we explored the experiences of individuals using telemedicine in Hong Kong during the COVID-19 pandemic to understand their risk perceptions and preparedness measures. We conducted a cross-sectional online survey of telemedicine users of private clinic-based COVID-19 testing services from 6 April to 11 May 2020. All users were invited to complete an anonymous online survey regarding COVID-19 risk perception and preparedness measures. The results of the survey were compared with the findings of a previous territory-wide survey. In total, 141 of 187 telemedicine users agreed to participate; the response rate was 75.4%. Of the participants, 95.1% (116/122) believed that telemedicine consultations were useful. Nearly half of the participants (49.0%) agreed or strongly agreed that telemedicine consultations were appropriate during the COVID-19 pandemic. Most participants believed that telemedicine consultations could perform the functions of 'health protection, promotion and disease prevention' (73.6%) and 'diagnosis' (64.0%). Concerning the choice of telemedicine provider, almost all participants (99.2%) were willing to consult medical doctors; more than half of the participants (54.1%) were willing to consult registered nurses, but only 13.1% were willing to consult non-clinical staff who had been trained to provide telemedicine services. The use of telemedicine for screening and patient education can be encouraged during the COVID-19 pandemic in Hong Kong.

Patient and provider perspectives on telemedicine use in an outpatient gynecologic clinic serving a diverse, low-income population.

To evaluate patient and provider experiences using telemedicine for gynecologic visits among a diverse, low-income population. Patients attending telemedicine visits at a resident-run gynecology clinic completed a modified Telemedicine Usability Questionnaire and providers completed a survey addressing satisfaction and barriers for each visit. The Telemedicine Usability Questionnaire included six subscales to assess telemedicine usability with 1-5 Likert-scale responses. Statistical analyses included Chi-square, Fisher's exact, Wilcoxon rank sum, Wilcoxon signed-rank, and two-sample t-test. Of 192 patients enrolled, 157 (82%) completed the surveys (87% video visits, 13% telephone visits). Most patients were ethnic minorities (non-Hispanic White-16%, Hispanic-32%, Black-28%, Asian-10%), median age was 40 years (range 18-69), and 63% reported income under $40,000. The total mean Telemedicine Usability Questionnaire score was 4.3/5. The reliability subscale score (3.72/5) was lower compared to all other subscales (p < 0.001). Older respondents were more likely to find telemedicine unreliable (mean age >44 vs <39, p = 0.02). Without telemedicine, 54% would have traveled ≥1 h to appointments, with 46% spending over $35 on travel, and 27% missing ≥ 1 workday. Patients preferred telemedicine for follow-up rather than initial visits (81% vs 33%, p < 0.01). Among providers, residents felt less adequately trained in telemedicine compared to nurse practitioners and fellows (54% vs 46%, p = 0.039). Low-income women utilizing telemedicine for outpatient gynecologic care report positive experiences with improved access to healthcare, cost, and time savings compared to in-person visits. Provider experiences were also positive; however, teaching hospitals must evaluate whether trainee providers feel adequately trained to deliver telemedicine visits.

Quantifying Urban-Rural Inequality in Access to Telemedicine: Descriptive Analysis of Telemedicine Uses and Providers in Japan Under COVID-19.

Background: COVID-19 has reportedly resulted in disparities in the use of telemedicine due to several socioeconomic factors. While telemedicine was developed to overcome geographical distance, under COVID-19 telemedicine conversely might have deepened the urban-rural telemedicine divide. Especially in Japan, the authority has virtually regulated distant telemedicine use, which favored telemedicine providers who are located in close proximity to patients. This study aimed to quantify the urban-rural disparity in access to telemedicine and investigate heterogeneity between devices (phone and video visits). Methods: We used two nationally comprehensive data sources in Japan. One was a municipality-level telemedicine provider database. Municipality-provider-level analysis intended to measure the uneven distribution of telemedicine providers compared to usual health care providers as well as the difference among clinical departments. The second source was prefecture-level telemedicine utilization data. Prefecture-utilization-level analysis aimed to quantify how the use of telemedicine converged in urban areas. We investigated the heterogeneity between types of devices and time periods. To measure inequality, this study used the Lorenz Curve and Gini coefficients. Ethical review was not required. Results: The data included 16,927 providers (14,111 clinics and 2,816 hospitals) and 88,952 first visits throughout Japan. The main findings were the geographically converged distribution of telemedicine providers compared with overall providers who were not limited to telemedicine and, possibly as a result of it, the geographically unequal utilization of telemedicine compared with in-person visits. Furthermore, video visits were more unequally utilized than phone visits, let alone in-person visits. The disparity was not resolved over time, which implied a systematic cause. Conclusion: Using comprehensive nationwide data, this study revealed geographical inequality relating to access to telemedicine under the COVID-19 special deregulation in Japan. While telemedicine initially aimed to provide access to care for people in rural areas, several factors, including the digital divide, COVID-19, and the Japanese policy, paradoxically could have caused this disparity.

Variations in Physician Telemedicine Provision

This cross-sectional study assesses variation in the provision of telemedicine services among primary care physicians and quantifies the extent to which this variation may be explained by the individual physician vs temporal, patient, or visit factors.

Telemedicine competition, pricing, and technology adoption: Evidence from talk therapists

This paper examines how new telemedicine competitors affected incumbent health care providers during the first waves of COVID-19. Using data from the largest mental health provider search platform in Canada, I show that increased telemedicine competition in a market caused incumbent providers in that market to stop offering income-based discounts to patients. I isolate the causal effect of competition in a difference-in-differences framework, comparing providers before and after a supply shock on the platform that exogenously assigned some markets new telemedicine search results. I find that higher-quality providers are more likely to stop income-based discounts when facing new telemedicine entrants, while lower-quality providers are more likely to exit the platform, which is consistent with telemedicine providers competing for more price-sensitive patients. The results suggest that expanding telemedicine options had a heterogeneous effect on the affordability of care.

Perceptions About Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers.

Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR's implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology. This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology. Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR's potential in remote health care. Interviews were transcribed and analyzed via thematic coding. Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR's adoption. AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine.

Patient satisfaction with telemedicine in the Philippines during the COVID-19 pandemic: a mixed methods study

BackgroundThe capacity to deliver essential health services has been negatively impacted by the COVID-19 pandemic, particularly due to lockdown restrictions. Telemedicine provides a safe, efficient, and effective alternative that addresses the needs of patients and the health system. However, there remain implementation challenges and barriers to patient adoption in resource-limited settings as in the Philippines. This mixed methods study aimed to describe patient perspectives and experiences with telemedicine services, and explore the factors that influence telemedicine use and satisfaction.MethodsAn online survey consisting of items adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group Adult Visit Survey 4.0 (beta) and the Telehealth Usability Questionnaire (TUQ) was completed by 200 participants aged 18 to 65 years residing in the Philippines. A subsample of 16 participants was interviewed to provide further insights on their experiences. We used descriptive statistics to analyze survey data and thematically analyzed data from interviews guided by the principles of grounded theory.ResultsParticipants were generally satisfied with telemedicine, and found it to be an efficient and convenient means of receiving healthcare. About 3 in 5 perceived telemedicine as affordable, with some finding telemedicine costs to be high and comparable to in-person consultations. Our results suggest that participants preferred telemedicine services, especially in cases where they feel that their condition is not urgent and does not need extensive physical examination. Safety against COVID-19, privacy, accessibility, and availability of multiple communication platforms contributed to patient satisfaction with telemedicine. Negative perceptions of patients on quality of care and service related to their telemedicine provider, inherent limitations of telemedicine in the diagnosis and management of patients, perceived high costs especially for mental health conditions, and poor connectivity and other technological issues were barriers to telemedicine use and satisfaction.ConclusionTelemedicine is viewed as a safe, efficient, and affordable alternative to receiving care. Expectations of patients on costs and outcomes need to be managed by providers to increase satisfaction. Continued adoption of telemedicine will require improvements in technology infrastructure and technical support for patients, training and performance evaluation of providers to ensure quality of care and service, better patient communication to meet patient needs, and integration of telemedicine services in remote areas that have limited access to medical services. Telemedicine, to realize its full potential, should be centered in health equity – addressing patient barriers and needs, reducing health disparities across population groups and settings, and providing quality services to all.

Telemedicine in Overactive Bladder Syndrome.

This review discusses the role and benefits of telemedicine as an integral component of the post-pandemic care paradigm in urological practice and, in particular, as part of the care of patients with overactive bladder (OAB). The COVID-19 pandemic accelerated the implementation of telemedicine across almost every medical specialty and (at least temporarily) swept away barriers including those regarding reimbursement and licensure. Telemedicine benefits patients and providers alike including savings on transportation costs, access to specialists or tertiary care from geographically remote locations, and minimized exposure to a contagious illness. Integration of telemedicine into clinical practice can reduce costs for office/exam space and staffing overhead, as well as facilitate greater scheduling efficiency. Many, if not most, aspects of care for the uncomplicated OAB patient can be as effectively managed remotely as with in-person encounters, across the treatment algorithm. Telemedicine will almost certainly remain a key component in the care of OAB, general urology, and throughout all medical specialties.

Implementation of a women’s reproductive behavioral health telemedicine program: a qualitative study of barriers and facilitators in obstetric and pediatric clinics

BackgroundPerinatal Mood and Anxiety Disorders and Substance Use Disorders are common and result in significant morbidities and mortality. Despite evidence-based treatment availability, multiple barriers exist to care delivery. Because telemedicine offers opportunities to overcome these barriers, the objective of this study was to characterize barriers and facilitators to implementing a mental health and substance use disorder telemedicine program in community obstetric and pediatric clinics.MethodsInterviews and site surveys were completed with practices engaged in a Women’s Reproductive Behavioral Health Telemedicine program (N = 6 sites; 18 participants) at the Medical University of South Carolina and telemedicine providers involved in care delivery (N = 4). Using a structured interview guide based on implementation science principles, we assessed program implementation experiences and perceived barriers and facilitators to implementation. A template analysis approach was used to analyze qualitative data within and across groups.ResultsThe primary program facilitator was service demand driven by the lack of available maternal mental health and substance use disorder services. Strong commitment to the importance of addressing these health concerns provided a foundation for successful program implementation yet practical challenges such as staffing, space, and technology support were notable barriers. Services were supported by establishing good teamwork within the clinic and with the telemedicine team.ConclusionCapitalizing on clinics’ commitment to care for women’s needs and a high demand for mental health and substance use disorder services while also addressing resource and technology needs will facilitate telemedicine program success. Study results may have implications for potential marketing, onboarding and monitoring implementation strategies to support clinics engaging in telemedicine programs.

Provision of Telemental Health Before and After COVID-19 Onset

To examine the organizational characteristics associated with telemedicine services provided by mental health care organizations before and after onset of the COVID-19 pandemic in the United States. Using 2019-2020 National Mental Health Services Survey data, we assessed changes in provisions of telemedicine services by mental health care facilities before and after onset of the COVID-19 pandemic. We estimated multivariable logistic regression models comparing pre- vs postpandemic changes in prevalence of telemedicine offered by mental health care facilities. We incorporated mental health care organizations' characteristics, including facility type, accepted payment, geography, and language service provisions, as well as state-level policies, such as payment parity laws, shelter-in-place laws, and number of COVID-19 cases. Mental health care facilities had 4 times the odds (odds ratio [OR], 4.3; 95% CI, 4.09-4.61)​​ of telemedicine provision post pandemic in 2020 compared with prepandemic in 2019. In 2020, facilities that accepted Medicaid (OR, 1.3; 95% CI, 1.11-1.49) and Medicare (OR, 1.3; 95% CI, 1.14-1.39) were more likely to provide telemedicine than those that did not. Facilities that offered American Sign Language (OR, 1.3; 95% CI, 1.16-1.43) and non-English language services (OR, 1.3; 95% CI, 1.15-1.44) were more likely to provide telemedicine than facilities that did not. Facilities located in states with payment parity laws (OR, 1.2; 95% CI, 1.11-1.36) were more likely to offer telemedicine than states without. Telemedicine availability in mental health facilities has expanded post COVID-19 pandemic, but telemedicine provision has been uneven across organizational and state-level factors. Expansion of regional investments and payment parity might be necessary to ensure equitable provision of telemedicine.